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Children with inherited bleeding disorders often require central venous catheters (CVC). Although CVCs are known to be complicated by deep venous thrombosis (DVT), little is known about the timeline of DVT development or risk of post-thrombotic syndrome (PTS).

Aim

To determine the timeline and confirm the incidence of thrombosis in patients with bleeding disorders who have CVCs.

Methods

In 2002 we instituted a screening program to monitor for CVC-related complications in children with hemophilia and von Willebrand disease. This is a retrospective review of this cohort. All children with CVC followed between January 1, 2000 and June 1, 2009 were evaluated for DVT every 24 months with contrast venography and Doppler sonography. An institutional PTS severity scale was utilized at each visit.

Results

Thirty-six patients had 37 CVCs placed. Thirty patients had imaging studies, with DVT observed in 14 (47%). Most DVT were diagnosed at the first venogram (median CVC duration 26 months). There were no abnormal ultrasound results. Sixteen patients (44%) had clinical findings consistent with PTS, including 10 (71%) with an abnormal venogram. Dilated chest wall veins appeared to be more strongly associated with underlying DVT (positive predictive value of 0.8) than arm circumference discrepancy. Successful transition to use of peripheral veins occurred at a median of 11 months after abnormal venograms.

Conclusions

CVC-related DVT is common in children with inherited bleeding disorders, and likely occurs earlier than previously thought. Clinical signs of PTS are also common, but long-term sequelae and severity of PTS are not known.

The demographic and clinical characteristics of adults and children with lower extremity deep-vein thrombosis and/or pulmonary embolism (LE DVT/PE) may differ from those with abdominal vein thrombosis (abdominal VT). Abdominal VT can be a presenting ...

United States, Agency for Healthcare Research and Quality.; Johns Hopkins University, Evidence-based Practice Center.; Centers for Disease Control and Prevention (U.S.), Office of Public Health Genomics.;

Prepared for Agency for Healthcare Research and Quality ; prepared by The Johns Hopkins University Evidence-based Practice Center ; investigators, Jodi B. Segal ... [et al.]. : This report was requested and funded by the Centers for Disease Control a...

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